Provider Demographics
NPI:1609155795
Name:RUDY, TALIA ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:ANNE
Last Name:RUDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W RACE ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3159
Mailing Address - Country:US
Mailing Address - Phone:937-397-8476
Mailing Address - Fax:
Practice Address - Street 1:814 W RACE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3159
Practice Address - Country:US
Practice Address - Phone:937-397-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145309164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse